title: Viral suppression and antiretroviral medication adherence among alcohol using HIV-positive adults.
abstract: BACKGROUND
  Substance use is a known predictor of poor adherence to antiretroviral therapies (ART) in people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome. Less studied is the association between substance use and treatment outcomes, namely, suppression of HIV replication.
  
  
  METHODS
  Adults living with HIV (N = 183) who reported alcohol use in the previous week and receiving ART were observed over a 12-month period. Participants completed computer interviews, monthly unannounced pill counts to monitor ART adherence, and daily cell-phone delivered interactive-text assessments for alcohol use. HIV viral load was collected at baseline and 12-month follow-up from medical records. Analyses compared participants who had undetectable HIV viral loads at baseline and follow-up (sustained viral suppression) to those with unsustained viral suppression. Analyses also compared participants who were adherent to their medications (>85 % pills taken) over the year of observation to those who were nonadherent.
  
  
  RESULTS
  Fifty-two percent of participants had unsustained viral suppression; 47 % were ART nonadherent. Overall results failed to demonstrate alcohol use as a correlate of sustained viral suppression or treatment adherence. However, alcohol use was associated with nonadherence among participants who did not have sustained viral suppression; nonadherence in unsustained viral suppression patients was related to drinking on fewer days of assessment, missing medications when drinking, and drinking socially.
  
  
  CONCLUSIONS
  Poor HIV treatment outcomes and nonadherence were prevalent among adults treated for HIV infection who drink alcohol. Drinking in relation to missed medications and drinking in social settings are targets for interventions among alcohol drinkers at greatest risk for poor treatment outcomes.
authors.affiliation: Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA, seth.k@uconn.edu.
authors.forename: Seth C
authors.initials: SC
authors.lastname: Kalichman
authors.forename: Tamar
authors.initials: T
authors.lastname: Grebler
authors.forename: Christina M
authors.initials: CM
authors.lastname: Amaral
authors.forename: Megan
authors.initials: M
authors.lastname: McNerney
authors.forename: Denise
authors.initials: D
authors.lastname: White
authors.forename: Moira O
authors.initials: MO
authors.lastname: Kalichman
authors.forename: Chauncey
authors.initials: C
authors.lastname: Cherry
authors.forename: Lisa
authors.initials: L
authors.lastname: Eaton
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D000437:Alcoholism / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D019966:Substance-Related Disorders / Q000453:epidemiology; D016896:Treatment Outcome; D019562:Viral Load; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents